IPA, Network Provider Specialist [DALLAS]

• Completes new provider orientation for all applicable product lines.
• Conducts provider group meetings to review monthly/quarterly data and outcomes.
• Responsible for meeting minutes and follow-up on ‘TO DO’ items identified at meetings.
• Conduct site visits to service providers, resolve issues, educate staff and providers on policies, and collect credentialing information.
• Conduct site visits to service providers and educate staff and providers on submitting Risk Adjustment Factor Data and HEDIS information.
• Maintains relationships with contracted HMOs to implement amendments to DOFR, delegation, policy, and procedures.
• Returns all routine calls from providers within 24 hours to establish consistent and robust relationships with provider offices.
• Provide oversight on inquiries and claims issues and follow up with providers to ensure problems have been resolved.
• Maintains provider office tools, including provider manual.
• Supports regional Network Improvement Plan targets by providing utilization reports, ER contingencies, Frequent Flier Reports, and other analytics available to improve /maintain regions.
• Identifies network gaps and completes contracts for PCP, Specialist, and Ancillary networks with in-depth knowledge of different fee schedules (Medicare/Medical/ASP/AWP).
• Identifies new cost-saving possibilities through working with various committees, such as UM and Claims.
• Understands and explains risk contracts (shared risk/entire risk).
• Strategizes for membership growth and retention.
• Provide training, mentoring, and guidance to new representatives.
• Works on special projects as assigned or directed.

Do you have experience in Vendor relationship management?, Do you have a Bachelor’s degree?, * Knowledge of MS Office: Word, Excel, PowerPoint, Access Database.

• Knowledge of MS Provider relations/customer service strategies.
• Knowledge of MSO-VL and MMSE programs and services: Authorizations, Claims, Credentialing encounters, RAF, Star Ratings, IS/IR, etc.
• Knowledge of Network development strategies and Provider Relations experience or similar background.
• Knowledge of current MSO-VL and MMSE geo-access requirements.
• Effective and efficient oral and written communication skills.
• Knowledge of County provider demographics.
• Skills in negotiating contract language and rate structures.
• Skills to provide training and technical assistance to contracted providers.
• Skills to evaluate and assess provider network to determine gaps and services needed.
• Skills to identify and develop new providers to ensure accessibility.
• Skills to monitor contract performance through site visits and data analysis.
• Skills to facilitate contracted provider meetings.
• Ability to represent the department or division professionally.
• Ability to establish and maintain effective working relationships with contracted and potential providers.
• Ability to resolve provider inquiries or requests promptly., * Bachelor’s Degree in Marketing or Business Administration
• Minimum of 2 years experience in Network Management within a managed care environment, health plan, or significant medical group administration.

Pulled from the full job description

• Health insurance
• Paid time off
• Vision insurance
• Dental insurance
• Flexible spending account
• Life insurance, * 401(k) matching
• Dental insurance
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance